胸段食管癌颈、胸、腹三野扩大根治术

EXTENDED THREE-FIELD(CERVICAL,THORACIC AND ABDOMINAL)LYMPH NODE DISSECTION FOR THORACIC ESOPHAGEAL CARCINOMA

目的 通过扩大颈、胸、腹三野淋巴结清扫提高胸段食管癌的手术根治性和外科分期的正确性。方法 40例胸段食管癌患者在切除肿瘤的同时接受了颈、胸、腹三野淋巴清扫术 ,清扫范围包括双侧下颈 (1 0 1组 ) ,锁骨上区 (1 0 4组 )和全纵隔 (1 0 5～ 1 1 1组 )及上腹部区域淋巴结。结果 36例 (90 % )患者获根治性切除 ,术后并发症 1 8例 (45 .0 % ) ,手术死亡 1例 (2 .5 % ) ,2 3例 (57.5 % )淋巴结受累。颈部、上纵隔、中下纵隔和腹部淋巴结转移率分别为 30 .0 %、2 0 .0 %、30 .0 %、2 2 .5 % (P >0 .0 5)。由于淋巴结清扫范围扩大使 1 2例 (30 % )患者获得常规术式无法获得的根治性切除及正确的病理分期。结论 胸段食管癌早期即可发生广泛及跳跃性淋巴结转移 ,扩大淋巴结清扫范围有利于提高手术根治性和外科分期的正确性。

Objective To improve radical resection rate and the accuracy of surgical stage for thoracic esophageal carcinoma through extended three-field lymph node dissection. Methods 40 patients with thoracic esophageal carcinoma underwent tumor resection and extended three-field(cervical,thoracic and abdominal)lymph adenectomy. The extent of lymph node dissection included two cervicos(101 station).Upper-clavicules(104 station),total mediastinums(105～111 station)and upper abdominal lymph nodes. Results 36(90%) cases underwent radical resection, 18(45%) cases developed postoperative complications. 1(2.5%)case died after operation. Regional lymph node metastasis occurred in 23(57.5%)cases. The transfer rate of lymph nodes in cervix, upper-mediastinum, mid-and inferior mediastinum and upper abdominal lymph nodes were 30%,20%,30% and 22.5% respectively(P>0.05).12(30%) cases with tumor were radically resected and correctly staged as N 1,and would have been resected palliative and misdiagnosed as N 0 stage if they had received routine operations. Conclusion Thoracic esophageal carcinomas are prone to have early, extensive or jump lymph node metastasis. Extend three-field lymph node dissection may help increase radical resection rate and the accuracy of surgical stage for thoracic esophageal carcinoma.